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The leaked Republican replacement

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The leaked Republican replacement

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The text of a draft bill to repeal and replace Obamacare leaked on Friday. Because the draft hews to principles that Republicans have outlined before, its basic contours aren’t that surprising. As I explained to Greg Sargent at the Washington Post:

The emerging GOP replacement would repeal tax hikes on the very rich and, instead, impose a tax [on employer coverage] that would hit many more people, including lots of public employees like schoolteachers and police officers. At the same time, it would slash Medicaid for the poorest Americans, as well as subsidies that the near-poor rely on to buy private coverage.

Drilling down to details, I had some observations. Take these with a big grain of salt: the leaked draft is dated February 10, so we don’t know how closely it resembles what’s currently under discussion in the House.

IBM Watson Health debuts cloud solutions for value-based care

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http://www.healthcaredive.com/news/ibm-watson-health-debuts-cloud-solutions-for-value-based-care/436527/

Dive Brief:

  • IBM Watson Health unveiled a new series of value-based cloud solutions aimed at helping providers, health plans and employers better manage their healthcare costs and quality.
  • The solutions — debuted at HIMSS17 in Orlando, FL—will integrate patient-level data from electronic health records and other sources to enhance understanding of different patient populations, risk factors and red flags at the individual, group and population level.
  • Watson Health also announced an agreement with Atrius Health to develop a cloud-based service to improve the doctor-patient experience.

Dive Insight:

The shift to value-based care and reimbursement models is forcing hospitals, payers and employers to rethink the way they manage risk in patient populations and come up with new approaches to improve quality while reducing costs. However, CMS’ new Quality Payment Program lacks needed IT infrastructure for collecting the data allowed by MACRA, which implemented the program, a recent HHS report concluded. But IBM is not the only company hoping to provide helpful solutions for value-based care. Earlier this month, Epic said it will incorporate care management content into its electronic health records (EHRs) and Health Catalyst deployed a new software tool that can be used to identify and align quality measure selection.

The value-based solutions set combines capabilities of Watson Care Manager, Truven Health Analytics, Phytel and Explorys. Initial applications, to be rolled out later this year, will focus on provider performance, patient engagement, bundled payments forecasting and management and custom analytics. Under the agreement with Atrius Health, Watson Cognitive Insights will combined the various influences on an individual’s health, including behavioral determinants, to improve primary care physicians’ effectiveness and efficiency and the quality and safety of ambulatory care. Among other things, the IBM solution could summarize key cognitive insights about a patient’s health status, assemble a de-identified cohort of similar patients and predict how those people might respond to various treatment options, according to the company.

During her keynote address at HIMSS17, IBM CEO Ginni Rometty talked of a new “golden age” in healthcare, thanks to cognitive computing, digitalhealth reports. Yet the industry must work to ease concerns about transparency, privacy of personal health information and artificial intelligence replacing highly skilled healthcare workers, she said. Rometty urged companies to invest in scalable — rather than piecemeal — solutions and to support an open platform, noting that will allow users to combine data being generated with their own insights.

A Surprising Place to Find Anti-Kickback Rules

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http://www.medpagetoday.com/MeetingCoverage/HIMSS/63409?xid=nl_mpt_DHE_2017-02-25&eun=g885344d0r&pos=4

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Some aspects of EHRs, telemedicine might technically be illegal.

Federal anti-kickback laws may be old, but they’re still relevant, even with something very modern like health information technology (IT), Scott Grubman, JD, said here Thursday at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

“So much technology in the healthcare space is to facilitate referrals,” such as when one provider transmits information to another, said Grubman, an attorney at Chilivis, Cochran, Larkins & Bever, in Atlanta. “If those referrals wind up being reimbursed by a federal healthcare program, a company can violate the anti-kickback statute.”

An 82-Year-Old Law

The anti-kickback statute, a version of which was first passed in 1935 and has been amended several times since with the introduction of Medicare and Medicaid, prohibits anyone from “knowingly and willfully paying, offering, soliciting, or receiving remuneration” in return for referring patients to services that are paid for by Medicare, Medicaid, and other federal healthcare programs.

The statute not only prohibits payments to providers, but also prohibits remuneration to beneficiaries, which means services like telemedicine and electronic health records (EHRs) might also be involved, Grubman noted.

Although the government says it wants to encourage technology growth in healthcare, “unfortunately sometimes what they don’t realize is that regulations that have been on the books for years — and are still applicable — don’t mesh well with the explosion of healthcare technology.”

There are two ways technology could be implicated in violations of the anti-kickback rule, he continued. The first way is if technology is being given to a provider to be used to actually issue the referrals that are implicated in the act — in bygone days this would mean if physicians are given fax machines to fax referral orders for which they get bonuses.

“There is lots of guidance [in the rule] that’s related to fax machines, so we have to figure out how to apply [the fax machine guidance] to the provision of tablets or electronic health records [to doctors],” he said.

The second way is if a technology that is used in any way to facilitate referrals — such as to provide the medical information to justify a referral order. “So if there’s technology that can facilitate a referral between a physician and a hospital, or between a hospital and pathology lab, that technology potentially implicates the anti-kickback statute.”

On the Far Side of Broken Trust – Hope for Those Who Have Been Betrayed

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On the Far Side of Broken Trust – Hope for Those Who Have Been Betrayed

Betrayal and broken trust brings immense pain.

I know. I’ve been there. And you probably have too.

When we talk about breaking trust, there is a continuum of severity of the offense. My fellow trust activists, Dennis and Michelle Reina, have an excellent way of expressing this concept. First, you can categorize offenses as either major or minor. Second, within those categories you can view the offenses as intentional or unintentional. The severity of the trust betrayal happens on a continuum, from those instances where a person unintentionally behaves in a way that erodes someone’s trust, to those instances where the person intentionally behaves in a way to deceive or betray.

When we’ve experienced an intentional, major betrayal of trust, it can seem like all hope is lost of salvaging the relationship. After all, isn’t that the truth behind the cliché “trust takes a long time to build and just a second to lose?”

I’m here to tell you that there is hope on the far side of broken trust. If you and the other party are committed to restoring the relationship and putting in the necessary time and effort to rebuild trust, there is hope for the future. There are three important ideas to consider and remember:

1. Trust is incredibly resilient—Trust is much stronger than we give it credit for, as most people who have had long-term relationships can testify. Trust experiences ups and downs over the course of time, but if both parties learn to develop open and honest communication and practice forgiveness and restoration when minor trust offenses occur, they develop the strength necessary to weather a major breach of trust.

2. Trust can be stronger after a betrayal—Once a relationship experiences an intentional, major betrayal of trust, it will never be the same. But it can be better, deeper, and stronger than it was before. Betrayals of trust often cause the parties involved to realize the value of their relationship. Instead of taking it for granted, the parties can gain a new perspective on the importance and priority of the relationship and work to make it healthier than it was before the breach of trust.

3. It’s an opportunity for a new beginning…or a necessary ending—After experiencing a breach of trust, and before deciding to embark on the journey of rebuilding it, it’s important to consider if the relationship is worth preserving. For example, if your auto mechanic intentionally deceives you and charges you for repairs that weren’t needed, you may decide it’s better for you to end that relationship and find a new mechanic. That’s an easy choice with an impersonal service provider, but it’s quite another for a close personal relationship. Yet in spite of the pain caused by a betrayal in a close relationship, it presents an opportunity to pursue a new beginning. Both parties need to be absolutely committed to restoring the relationship in order to recover from a major betrayal of trust. Trust is a reciprocal process—one person gives it, the other returns it. You can’t rebuild it if only one party is committed.

Trust is the foundation of any healthy and thriving relationship. It may sound simplistic and perhaps counterintuitive, but the best way to build trust is to never break it in the first place. What I mean by that is trust is created through repeated interactions in a relationship where the parties prove themselves trustworthy to one another. The more trust is built over time, the stronger it becomes and is able to endure and persevere when a major betrayal occurs.

If you find yourself experiencing a betrayal, don’t despair. There is hope for having a stronger and deeper relationship as a result of going through the process of rebuilding trust.

 

Five takeaways from the leaked Republican bill to repeal Obamacare

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http://www.pbs.org/newshour/rundown/5-takeaways-leaked-republican-bill-repeal-obamacare/

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A formal draft of the House Republican plan to repeal and replace the Affordable Care Act leaked out on Friday.

The final version is likely to be different — how much different, it’s hard to say. The draft obtained by Politico is dated two weeks ago, and rumors have been swirling here that Republicans received an unfavorable analysis from the Congressional Budget Office, the official scorekeepers on the cost and coverage implications of legislation.

But this is nonetheless an important milestone — real legislative text, prepared with an eye toward the complex parliamentary procedures needed to pass ACA repeal with only Republican votes, and presumably with the endorsement of House leadership.

Much attention will be paid to the proposed tax credits offered for people to buy health insurance and the changes to the tax treatment of employer-based insurance. Here are five provisions with big implications for health and medicine.

 

What is a blind reference?

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What is a blind reference?

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Some people naively think that the only reference checking that is done is with the references given by a candidate or a head hunter.   Executives recruiting for talent will peruse your CV looking for places where you might have common acquaintances.  They will also look for places that some of their friends and professional contacts might have insights.  When these links are found which is most of the time for an experienced recruiter or hiring executive, you are about to become the victim of a blind reference.

A ‘blind reference’ is an investigation into your past by a hiring executive that you know nothing about.

I do not put a lot of faith in  references provided by a candidate.  I also disregard reference letters.  No one is going to intentionally give a reference that is going to provide a bad report on a candidate. The same is true of letters.  No one is going to write a letter that states the candidate is bad.  On occasion, I will write a reference later for someone as a personal favor but I aways counsel them that reference letters in my opinion are a total waste of time.  The only time I pay any attention to a reference letter is if I know the author.

Because of political correctness and the cold legal realities associated with references these days, the best you are going to get from formal references in most cases is that the candidate was hired on one date and departed on another date.  The most you are likely to learn is that the candidate actually did work for the firm you are contacting for the stated period of time.  They will rarely tell you anything more because references are subjective by nature in most cases.  Subjective references that cause a candidate to be ruled out of a search can become a liability for the person that gave the reference.  This is one of the reasons that blind reference checking has grown in my opinion.

If I get a call on a candidate being evaluated by another firm by someone I do not know, I refer the call to HR where I know what they are going to be told.  Even if the reference call comes from a friend,  I know the candidate and I know them to be bad, instead of giving a reference, I will refer my friend to HR where they will get the standard, canned response.  The hiring manager always gets the message.  If a friend encounters me refusing to give a reference, they understand the communication.

The more frequent call that I get is from a decision maker that is checking references that are not on the candidate’s list.  These are the calls that are dangerous for candidates because they are blind to the candidate; hence a blind reference call.  The candidate will never know in most cases they were vetted through a blind source.  This is one of the many reasons why it is so important to keep up your networking and to not burn bridges unnecessarily.  Of course the blind reference is not necessarily a bad thing.  Under the right conditions, it can propel you to the front of the line.  I received a blind reference call on a candidate I happened to be considering at the same time.  I told the blind reference caller that my reference is simple, “If you do not hire her, I will.”  I had worked with this candidate before and she is outstanding.  She was going to end up with a gig regardless of how the reference checking worked out in this case.